Ruminations by a non-academic general surgeon from the heart of the rust belt.

Friday, September 17, 2010

Ortho Corruption

This story about orthpedic surgeons not disclosing financial ties to the medical device manufacturers in their scientific papers is nothing new. Lack of transparency plagues the medical literature, especially in lucrative, product-driven fields like ortho and cardiology. What struck me were two points.

One, over half of orthopods who accepted over a million dollars from device companies in 2007 did not disclose this information in articles they published in the subsequent year. That's astounding. And illegal according to anti-kickback laws.

The medical device industry's practices were so flagrant that they prompted an investigation by the Justice Department. Indeed, the payments reported in the new study appear in Internet listings set up by five big orthopedic device makers — Zimmer, DePuy Orthopaedics, Biomet, Stryker and Smith & Nephew — as part of a September 2007 settlement that capped a federal inquiry of company kickbacks to doctors. Zimmer, DePuy Orthopaedics, Biomet and Smith & Nephew also paid the government $311 million in penalties.

Secondly, the amount of money is just staggering. The study from Archives of Internal Medicine indicates that 41 orthopods were paid a total of $114 million, with pay outs varying between $1-$8 million to each surgeon. My God, I chose the wrong specialty.

The good news is that there is some law that will go into effect in 2013 whereby a government database will keep track of doctor gifts/payments of more than $10 bucks. So we have that going for us. Which is nice.

C'mon Buckeye, the Pod's don't have it THAT good... They have to deal with all those whiny malingerers with low back pain, the occasional fat embolism, and umm thats about it. But they get to wear those cool Spacesuits, and do you know how expensive they are, just open one up sometime and you'll find out, examine Highschool Cheerleaders knees, and 2 words... "Methyl Methacrylate" I've seen God-Fearing-Southern-Baptist-Deacons turned into wildeyed savages after one whiff of its tantalizingly Sweet fumes, had a little trouble with it myself once...

Thanks for calling attention to that article. There are two further thoughts:1) Innovation is important, but it seems that the use of innovative devices by orthopedic surgeons on their patients outside of a clinical trial is subjective to many problems, not the least of which is the subject of who is paying for the surgeries and the post-operative care. It is one thing for the surgeries and the post-operative care to be paid for by the device makers, but when private/public insurers pay for them, it this ethical? I am not asking for randomized placebo controlled trials, but these patients are more or less, study patients, and should be treated as such.2) This makes us doctors look bad. Like real bad. Not only is non-disclosure wrong and fraught with dangers. But in a time when medical care is facing the very real danger of becoming something physicians would not recognize as desirable (because of time, money, and mediocrity imposed on us by private and public third party payers and litigants), it makes us look like we’re greedy. Greedy because we complain about Medicare cuts, long hours, personal sacrifices, but drive around in the latest model German sedan collecting fees from device makers. Of course, none of this is true, but it is so easy for the public to fall into this. I don’t want to destroy orthopedic surgeons lives, but this shit has to stop. In the next few years, I think the public’s awareness of the failures of Obama’s health care promises will become apparent. (He’s done nothing to help physicians and nurses make health more affordable, nor strengthened the role of generalists who play the greatest role in advising and counseling patients). I am worried the public will turn their anger towards the physicians and politicians will follow. (Obama’s tonsillectomy and amputations are an examples) This adds fuel to that.

Glad to see your not un-duly excited over Ohio States totally undeserved and if there's a God, short-lived time at the top of the College Football Polls, You know damn well they'd be lucky to finish 4th in the SEC West, maybe 5th if Ole Miss caught em on a down week... I know, I know, its not about Winning, its the "Tradition", "Dotting the "I"", "Brutus Beefcake Buggering Bevo VI behind the Goal Post", Woody Hayes punching the Clemson Defensive Back for exposing the Fraud that is Big 10(umm you've got 11 teams, oh yeah, Indiana/Purdue/Minnasoda/Illinois don't really count)Football...

I love reading your posts. I have a question, what would cause a year old, very nicely healed, midline insicion to spontaneously open near belly button and then you can measure 6" deep into the hole. I know you can't give medical advice.

Hey Buckeye, Hope you haven't committed Harry-Carey over your Buckeyes mercifully short rain at the top of the Poles...Seriously, Pope John Paul 1 didn't crash and burn as fast.I mean, the Space Shuttle, got my dead Popes/Space Disasters mixed up...But Buck up, Buckeye, you've still got the Browns.Oooh that was a cheap shot, I mean the Cav's, you got Lebron comin back, andOoohhh double cheap shot...hear the Indians have a really good southpaw down at Toledo...Sorry, just kidding, don't even know if Toledo's an Indians farm team...Woody Hayes is probaly rollin over I mean punchin a Clemson player in his grave...Frank, "SEC RULES!!!!!!!!!!!" Drackman

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